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Forms Can Be Submitted via. Email to lirrccotrolof,eyeLi)towii f\val) inf)ernyjzov or
&rn��nofwapping_ern gov or in person/via trail to 20 MiddlebUsh Rd Wappingers Falls, NY 12590
FOR INTERNAL USE ONLY
Received by: Joseph P, Paoloni U
Lori McConologue l=
Grace Robinson I
Date Received:
FOIL Ser. 4: a 2)-, —
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ASSESSOR
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ACCOUNTING
CODE ENFORCEMENT
HIGHWAY
RECEIVER OF TAXES
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RECREATION
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SUPERVISOR
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TOWN CLERK
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WATERISEWER
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DOG CONTROL OFFICER. El
TOWN ENGINEER
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TOWN ATTORNEY
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,,.8pficafion for Public Access to Records
'6�\fe FOIL REQUEST
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FOR DEPARTMENT USE ONLY
Date Received by Dept IL! , /
Department Head approval:
i t)
Date Applicant Contacted:
Date FOIL fulfilled or denied: 1 J m
Closed by:
Date:LLJ /
Notcs:
Amount Due: — Pages for• a total of $
Nance: Ginamerie Ingordino - - []cheek here if you are
Address: 201 Old Country Roadrequesting that the records
Melville, ICY 11747 be mailed to this address,
Agency or firth: Self
Telephone 4: (631 ) 605 _3757 FAX #: (631 ) 396 -1799
Email address: Rtqa rebuildn+,com
SPECIFIC DESCRIPTION OF RECORD:
I am requesting a lint of your Vacant / Blighted properties in the Town if you keep recorri.Thank you so much for your help.
FORMAT OF RECORD (if available)
Hlrequest to be notified when I can come to inspect the record(s) described above
T request copies of the records described above and agree to pay the cost of such records in
accordance with the fee schedule on the bade of this application
1 request that the records he sent via c -mail to the address listed above